Hormone replacement therapy: What you need to know

Menopause can bring discomfort and health risks, but HRT can help reduce these.

Hormone replacement therapy is used to help balance estrogen and progesterone in women around the time of menopause.

Also known as hormone therapy (HT) or menopausal hormone therapy (MHT), hormone replacement therapy (HRT) can help relieve sweating, hot flashes, and other symptoms of menopause. It can also reduce the risk of osteoporosis.

Does HRT cause cancer?

HRT was once widely used for reducing symptoms of menopause and protecting against osteoporosis and cardiovascular disease.

However, its benefits were questioned after two studies using data from the Women's Health Initiative (WHI) were published, in 2002 and 2003. Findings linked HRT to endometrial, breast, and ovarian cancer.

This caused many people to rethink the use of HRT, and it became less widely used.

Now, further research has questioned those investigations. Critics point out that the findings were mixed, and since different hormone combinations can have different effects, the results did not really show how hazardous or how safe HRT might be.

In the case of breast cancer, a combination of progesterone and estrogen was linked to one extra case of breast cancer per year for every 1,000 women.

Newer studies have suggested that the benefits of HRT may outweigh the risks, but there is still some confusion.

A report published in The BMJ in 2012 concluded that "HRT may or may not increase the risk of breast cancer."

be "quite effective" in preventing skin aging, if used cautiously in some women

It is now thought that HRT may not be so hazardous for some women, after all. It is currently approved to treat menopausal symptoms and to prevent or treat osteoporosis.

However, for anyone who is thinking of using HRT, this must be a careful and informed decision taken with a doctor who understands the individual's risks.

More evidence is needed, and research continues. It should also be remembered that aging is a natural human process. If HRT can protect against some changes that occur in women, it cannot prevent all aspects of aging.

The risk of breast cancer is now thought to rise if HRT is used for over 5 years. The risk of stroke or blood-clotting problems is not believed to be high for women aged 50 to 59 years.

It should not be used by women who are or who may become pregnant.

One fear about HRT is that it will cause women to gain weight. Women often gain weight around menopause, but research has shown that this is not necessarily due to HRT.

Other possible reasons for weight gain around this time include a drop in physical activity, a redistribution of fat as hormone levels change, and an increase in appetite resulting from a fall in estrogen.

Maintaining a healthy diet and getting plenty of exercise can help reduce weight gain.

Types of HRT for menopause

HRT can come as pills, creams, patches, or in a vaginal ring.

Common types of HRT use different combinations and delivery of the hormones.

Estrogen-only HRT: Women who have had a hysterectomy where their uterus, or womb, and ovaries have been removed do not need progesterone.

Cyclical, or sequential HRT: Women who are still menstruating but have perimenopausal-like symptoms can use this. Cycles may be monthly, with an estrogen plus progestogen dose at the end of the menstrual cycle for 14 days, or a daily dose of estrogen and progestogen for 14 days every 13 weeks.

Continuous HRT: This is used during postmenopause. The patient takes a continuous combination of estrogen and progestogen.

Long-cycle HRT: this causes withdrawal bleeds every 3 months. Its safety has been described as "questionable."

Local estrogen: This includes vaginal tablets, creams, or rings. It can help with urogenital problems, including dry vagina and irritations.

How does the patient take HRT?

The doctor will prescribe the lowest possible dosage to treat symptoms. This may take some trial and error.

Ways of delivering HRT include:

creams or gels

vaginal rings

tablets

skin patches

When HRT is no longer needed, patients will stop using it gradually.

Alternatives to HRT

A woman who is experiencing perimenopause can use alternative ways to relieve symptoms.

Alternative ways of reducing symptoms include the use of a fan.

These include:

Reducing consumption of caffeine, alcohol, and spicy food

Not smoking

Exercising regularly

Wearing loose clothing

Sleeping in a well ventilated, cool room

Adding a fan to the bedroom or cooling gel pad or pillows

Some SSRI-type antidepressants can help treat hot flashes, and the antihypertensive drug, clonidine, may help.

Anecdotal accounts say that consuming ginseng, block cohosh, red clover, soya beans and Kava help with menopausal symptoms. It is worth noting that the United States (U.S.) Food and Drug Administration (FDA) does not recommend or regulate herbal or supplement treatment, and research has not confirmed their benefits.

HRT is an effective treatment for symptoms such as sweating and hot flashes, but women should speak to their doctor and consider carefully before taking it.

Comments(3)

I am 74 y/o put on hrt in 1970 after complacations from childbirth where i had a total hysterectomy. at my age now still on it i have no blood pressure, diabetes, heart ds, my hair is long thick brown with small amt of grey, people think im in my 50's i feel good take care of my home, my mind is good,very little arthritis in my body or any other disease, that is the only prescription medicine i take but i take fish oil bid, muktiple vit. i have had problems with high cholesterol and trig. i recently started on red yeast rice for it and its down and sleep apnea on c-pap no 8 setting, i attribute my good health to my hrt .625mg at hs and would not ever want to get off of it.I feel that if i did get off of it i would start to age at a more normal pace.

My mother in law is 68 and is considering HRT at a Medical Spa. They actually call it bioidentical hormone replacement therapy. Is there anything that we should be aware of, is this type of facility able to provide proper therapy? Thanks

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